The Oral Approach

Communication Development

The oral approach is chosen when the family has decided to use spoken language. With this approach one of the main goals is to make use of the baby’s remaining hearing by using assistive technology (described below) that helps to make sounds loud enough for the baby to hear.

To help develop spoken language, different methods can be used, including an auditory-oral approach and auditory-verbal therapy. Both of these focus on speaking, listening, and later on, writing the language. The main difference between the two methods is that the auditory-oral approach does encourage lipreading or speechreading (i.e. watching the movements of the mouth, face, and body to understand what the speaking is saying), whereas auditory-verbal therapy focuses mainly on using the child’s listening abilities to learn spoken language.

Assistive Technology

Assistive technology refers to systems or devices designed specifically to help people hear better. The most commonly used devices for infants are hearing aids, FM systems, and cochlear implants. The main function of these devices is to make sounds louder and/or easier to hear. The term amplification is used when the device makes sounds louder.. Some form of amplification is commonly used when the goal is for the baby to make use of any remaining hearing.

Hearing Aids

A hearing aid is a small electronic device that makes sounds louder and is worn in or on the ear. Hearing aids can be adjusted to suit many kinds of hearing impairments. The hearing aid will be adjusted by the baby’s Audiologist so that it is fitted especially for each baby’s hearing impairment. The hearing aid can be adjusted so that soft sounds will be loud enough for the baby to hear, but loud sounds will not be made uncomfortable for the baby to hear. Although Hearing aids will help many babies hear better, they will not provide normal hearing.

If the baby has a hearing impairment in both ears, the family may decide on two hearing aids, one for each ear. This is called binaural amplification. Most scientific studies suggest that babies who have hearing impairment in both ears will do better with two hearing aids. Binaural amplification will help the baby hear sounds coming from all directions and may help the baby hear speech better in noisy situations.

Hearing aids can be fitted as early as a few months of age. If parents choose a hearing aid for their baby, the IHP recommends that the baby be fitted with hearing aids not earlier than 3 months of age, but before 6 months of age wherever possible. There are several difficulties in achieving a successful hearing aid fitting for a baby earlier than 3 months of age, because of the rapid changes in the baby’s ear. Scientific studies show that if a hearing aid is fitted before about 6 months of age, and adjusted properly, many babies will be able to hear sounds better and are likely to develop spoken language. In situations where the hearing aid is chosen but is fitted later than 6 months of age, the child can still benefit from the hearing aid.

Hearing Aid Technology
There are two main types of hearing aid technology: digital and analog. There are differences in how hearing aids work, and differences in the cost of the hearing aids. The baby’s Audiologist will discuss with the family the different hearing aid options, and will help decide what is best for the baby based on the hearing impairment and the baby’s needs.

Hearing Aid Styles
Hearing aids are available in different styles. Not all of the styles are appropriate for a baby, as a baby’s ear grows very quickly. The Behind-The-Ear (BTE) style is the best option for infants and young children for a number of reasons. This type of hearing aid can be adjusted easily if the baby’s hearing impairment changes, and can be more powerful if necessary for more severe hearing impairments. The BTE hearing aid fits behind the ear and has two parts:

The earmold – which keeps the hearing aid in place behind the ear, and delivers the amplified sound from the hearing aid to the baby’s ear canal through a soft plastic tube. An earmold is made from soft plastic especially for each baby, as the exact shape of each baby’s ear will be different. New earmolds will be needed as the size and shape of the ear changes as the baby grows.

The hearing aid – the electronics, which sit behind the ear. The electronic components of the hearing aid are enclosed in a hard plastic shell and deliver amplified sound through the earmold to the baby’s ear. The hearing aid is powered by a battery and will have an on/off switch. It may also have other controls.

Trial Period
In Ontario there is a minimum 30 day trial period with all hearing aids. During the trial period families will become familiar with how to use the hearing aid, the earmold, and any other accessories. During this time families may also notice changes in the how the child reacts to speech and other sounds. It is possible to return the hearing aid for credit during the trial period.

Assistive Devices Program
All babies identified with permanent hearing impairment in Ontario can receive money to help buy a hearing aid(s) through the Assistive Devices Program (ADP). ADP will help with the cost of the hearing aid up to $500 for each ear. The ADP program will help buy new hearing aids for the baby, if necessary, once every three years. For more information on the Assistive Devices Program, click here.

FM Systems

An FM system can be used by itself, but it is typically used together with hearing aids. A FM system uses radio waves to send the auditory signal directly from a microphone worn by the person speaking, to the receiver worn by the baby. FM systems have a number of advantages, including eliminating the effects of distance between the speaker and listener, making background noise softer, and increasing the loudness of the signal. FM systems are normally introduced once the baby is in a daycare or classroom-type setting. Funding for FM systems is available through the Assistive Devices Program.

Cochlear Implants

A cochlear implant is a surgically implanted electronic hearing device that provides individuals with the sensation of hearing by bypassing the damaged part of the ear and stimulating the hearing nerve directly. A cochlear implant is an option when the baby has very little remaining hearing, for example in severe or profound hearing impairment.

A cochlear implant may be of more help than hearing aids in some cases, especially when the hearing impairment is so severe that even the most powerful hearing aid cannot make the sounds loud enough for the baby to hear. Cochlear implant surgery involves placing tiny electrodes into the cochlea in the inner ear. These electrodes convert sound into electrical signals that go to the hearing (auditory) nerve. The cochlear implant surgery causes a permanent change to the cochlea, and any hearing that the baby had before the implant surgery may no longer be present. Once the decision is made to go ahead with a cochlear implant and the surgery is completed, a hearing aid can no longer be used on the implanted ear and the procedure cannot be reversed.

Having the cochlear implant surgery is just the first step. After surgery, the baby will hear many different sounds, but must learn what the sounds mean. Children with cochlear implants will require much training and language experience before learning to perceive and to produce meaningful speech sounds. Children with cochlear implants usually work together with speech-pathologists or auditory-verbal therapists to help them learn to understand language, and to talk.

The cost of the cochlear implant device and the cochlear implant surgery are covered by provincial programs. The cost of the training necessary to help the child learn how to listen with the implant is also currently covered.

Auditory-Verbal Therapy

The goal of the Auditory-Verbal Approach is to help children with hearing impairment use their hearing and listening ability in order to communicate through spoken (oral) language. This type of therapy helps children with hearing impairments to learn to use their amplified remaining hearing, and/or a cochlear implant to listen, understand verbal language and to speak.

An auditory-verbal therapist is a qualified teacher of the hearing impaired, an audiologist and/or speech language pathologist, who works closely with the child and develops a personalized therapy program. Most auditory-verbal programs offer weekly therapy sessions, lasting for an hour or hour-and-a-half each time. The family plays an important role in the auditory-verbal approach, as the family will learn skills which will help the baby to learn through listening, and to communicate through spoken language. Please visit www.learningtolisten.org for more information about auditory-verbal therapy.